Modelo de gestión organizacional: barreras y oportunidades en la conformación y fortalecimiento de una red institucional de investigación para la salud / Organizational management model: barriers and opportunities in the formation and strengthening of an institutional health research network

INTRODUCCIÓN La provincia de Mendoza cuenta con instituciones académicas y organismos gubernamentales que producen investigación en seres humanos, tanto del sector público estatal como el privado, con una lógica organizacional propia; las cuales han funcionado de individualmente o con algunas interrelaciones parciales entre ellas. OBJETIVOS Describir los factores que favorecen u obstaculizan la constitución de una red institucional de investigación para la salud. MÉTODOS Estudio descriptivo de corte transversal, con un análisis centrado en la noción de problema desde la concepción de planificación situacional. Se utilizaron técnicas de recolección de información con una metodología cuantitativa y cualitativa. La población objeto fueron las áreas de investigación formalmente establecidas, de los ministerios de salud de Mendoza, San Luis y La Rioja y las universidades de Mendoza. Desde los propios actores institucionales que conforman la red y los potenciales a sumarse, se describió la situación en la que se está y la que se querría alcanzar, a partir de la experiencia de la red de Mendoza. RESULTADOS Los procesos culturales son distintos para cada institución. Se visibilizaron algunos aspectos de las instituciones académicas y de organismos de gobierno. DISCUSIÓN La complejidad de los problemas abordados obliga a priorizar las causas críticas en cuanto a las políticas institucionales en investigación como problemas centrales el financiamiento, la formación del recurso humano y la articulación. Esta última es percibida por algunos actores como la única posibilidad de mantenerse y por otros, como estrategia de trabajo en busca de mejores resultados. Deberá plantearse el limitante que hoy tienen los investigadores a la hora de difundir sus trabajos científicos y provocar la discusión respecto a la necesidad de publicaciones y divulgación del conocimiento. La comunicación dentro de las organizaciones es un desafío percibido. La búsqueda constante y la reflexión sobre lo que pasa permitirán encontrar nuevas estrategias para potenciar la red.

[Magnetic resonance imaging in tendon and ligament injuries of the ankle. Our personal experience]. / La Risonanza Magnetica nelle lesioni tendinee e legamentose della caviglia. Esperienza personale.

While Magnetic Resonance Imaging (MRI) has become a routine diagnostic method in knee studies, little has been published about ankle injuries. This is probably due to the anatomic complexity of the bone and ligament structures of this joint. Our study was aimed at assessing the yield of MRI of the ankle with a cost-effective, compact, low-field (0.2 T) M(R) system (Artoscan, Esaote). January, 1994, to August, 1995, 148 ankle examinations were carried out in a series of patients whose age ranged 7 to 75 years. In 56.7% of cases the exam was performed because of acute joint strain and in 43.3% for pain and chronic ankle instability. In 16.2% of cases the exam was negative; in 41.2% osteochondral injuries were found (which are not considered in this paper) and in 62.1% of cases ligament and tendon injuries were demonstrated. As for the latter, 46 patients had anterior talofibular rupture, 3 associated anterior talofibular and calcaneofibular ligament injuries, 9 tenosynovitis of extensor or flexor tendons, 2 tendon rupture and 17 Achilles tendon conditions (10 chronic tendinitis, 2 bone metaplasia and 5 tendon rupture cases). Three tarsal tunnel syndromes and 3 accessory soleus muscles were also observed. Surgical correlation was available only in 17 patients; after radiography and MRI, the vast majority of patients was treated nonoperatively. Nevertheless, a good correlation was demonstrated between M(R) and intraoperative findings or clinical and US findings. The authors believe that low-field MRI can be a very useful diagnostic tool in the study of ankle tendon injuries and to assess the severity of ligament injuries, for better treatment planning.

[Ultrasonography of the shoulder: the acromioclavicular joint]. / Ecografia della spalla: l'articolazione acromio-claveare.

In 95% of the patients complaining of shoulder pain, pain is consequent to mechanical impingement of the coraco-acromial arch on the rotator cuff. Acromioclavicular joint conditions play a major role (well over 50%) in initiating the process. This study was aimed at assessing the value of acromioclavicular investigations during shoulder US studies. September 1992 to September 1993, a hundred and seventy-four patients with shoulder pain underwent US exams of both shoulders and acromioclavicular joints. In 62% of patients rotator cuff tears (from less to more severe) were demonstrated, in 48% biceps tendon conditions (effusion, tendonitis, dislocation or tear) and in 31% aspecific degenerative changes of the rotator cuff. Three acromioclavicular joint cysts, a clavicular fracture and an acromioclavicular dislocation were also observed. The patients with US patterns of acromioclavicular conditions were 105 (60%); in 38% of cases, only capsular hypertrophy due to joint degeneration was observed. In 22% of cases the latter was associated with arthrosis-like changes of the articular rim. In 63% of cases rotator cuff tears were associated and in 37% of cases there were aspecific degenerative cuff changes. The authors believe that, especially in the latter cases, acromioclavicular joint US can be a useful approach to diagnosis and treatment.

[Echotomography in the study of the pathology of Achilles tendon]. / L'ecotomografia nello studio della patologia del tendine di Achille.

Achilles tendon was evaluated by B scan ultrasound in 54 cases (20 normal and 34 symptomatic subjects). The ultrasonographic features of tendon's diseases were correlated with the anatomical patterns. On the basis on their experience, the authors concluded that ultrasonography is a simple and highly accurate method for the diagnosis of Achilles tendon diseases and that it should be the initial imaging procedure.